High blood pressure medication can cause unpleasant side effects so it’s not surprising many sufferers prefer to put up with it and risk future stroke, heart attacks, kidney problems and more.
Add on the fact that two out of five patients’ blood pressure (BP) remains stubbornly too high at more than 120/80mmHG, despite medication, and there’s an urgent need for new approaches.
How to measure your blood pressure
So a slew of devices and drugs designed to target what’s now thought to be the underlying cause of high BP, the sympathetic nervous system – which controls automatic activities such as blood pressure, breathing and heart rate - are now in development.
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Breakthrough 1: Renal denervation (RDN)
A procedure to destroy nerves serving the kidneys - renal nerves – using radiofrequency or ultrasound, delivered via a guiding catheter. Renal nerves are part of the sympathetic nervous system.
Destroying these nerves can reduce hypertension that hasn’t responded to other drugs and NICE has now given RDN a cautious thumbs up, so it is now available in some hospitals.
Breakthrough 2: Carotid body receptor blocker
This new drug works by quelling overactivity in the carotid bodies, two tiny organs no bigger than a grain of rice thought to be key to BP control.
‘They are the guardians of blood flow to the brain,’ explains Professor Julian Paton, of Bristol University, who is working on the drug, with support from the British Heart Foundation. Strategically situated close to the carotid artery in the neck, which supplies blood to the brain, they sense whether enough oxygen is reaching our most important organ.
‘If it isn’t - or if they are fooled into thinking it isn’t, perhaps as a result of inflammation or hardened arteries - they go into overdrive triggering messages that “tell” the sympathetic nervous system to narrow arteries. This preserves blood supply – and oxygen – to the brain but at the expense of causing high blood pressure,’ explains Professor Paton.
Trials of the drug are about to begin. If successful, it could be a truly bespoke treatment for people with uncontrolled hypertension or who experience unacceptable side effects from existing medication.
Breakthrough 3: Arterio-venous anastomosis
Involves a device – the Rox coupler – being inserted between the artery and vein in the upper thigh in a keyhole procedure. It enables blood to be transferred from the artery to the vein, reducing the volume of blood in the artery and other physiological reactions involved in high BP.
Patients using the device have been able to reduce medication as well as avoiding complications of high BP and hospital admissions. However, says blood pressure expert Dr Manish Saxena from London’s St Bartholomew’s Hospital, who is researching the device, ‘It looks promising but it’s essential we choose the right patients.’
Breakthrough 4: Baroreflex Activation Therapy (BAT)
Similar to a pacemaker, this pulse generator is implanted under the skin and delivers electrical signals via an electrode to pressure sensors – called baroreceptors – in the carotid arteries. These trigger something called the carotid baroreflex, which controls blood pressure by regulating activity of the sympathetic nervous system.
Still on trial but another promising treatment.
Breakthrough 5: Median Nerve Stimulation
A gadget the shape and size of a coin – known as the eCoin System – implanted in the lower forearm under local anaesthetic in a ten-minute procedure. It delivers a light electric current for 30 minutes a week and works on the same principle as Chinese acupuncture by stimulating a nerve in the arm. This has been shown to lower BP.
Trials started in November this year, with results due in 2018.
For our great article on blood pressure and new and easy ways to reduce it, see the December issue of Saga Magazine.
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